Syphilis

Syphilis is a chronic, degenerative, sexually transmitted disease. Highly contagious particularly during the early stages of its progression--syphilis can be cured in its primary and secondary stages with penicillin administered over a prolonged period, although treatment in the primary stagefails approximately two to 20% of the time. Left untreated, it continues, eventually causing serious damage to the nerves, brain, eyes, heart, and other organs. Although the incidence of syphilis has been reduced somewhat through education programs and medication, the incidence remains high and has risen dramatically in connection with the AIDS virus, making it a public health concern around the world.

Spread primarily by sexual contact, syphilis begins as a small, hard, painless sore, called a primary (or Hunter's) chancre, which disappears in one to five weeks after infection. Left untreated, the disease passes into the secondary stage, lodging in the lymph nodes. Within 6-12 weeks,discolored patches appear on the palms of the hands and soles of the feet; skin sores, mucous patches in the mouth, throat and cervix, and a body rash appear; along with patchy hair loss and flu-like symptoms. This second stage can last two to six weeks. Left untreated, syphilis goes into its latent stage,during which no symptoms are evident. One in every three people with latentsyphilis develop third stage disease which becomes evident from 10-40 years after the primary stage, and can lead to paralysis and death. Pregnant women infected with the disease can transmit the infection to the unborn child, causing congenital syphilis. Approximately 40% of these babies die and most of those who live suffer serious abnormalities.

The earliest records of syphilis are those of Spanish physician, Rodrigo Ruizde Isla, who wrote that he treated syphilis patients in Barcelona in 1493. He further claimed that the soldiers of explorer Christopher Columbus contracted the disease in the Caribbean and brought it back to Europe in 1492. However, others challenge this position. Some medical historians believe that syphilis has been present from ancient times but was often mislabeled or misdiagnosed.

Italian physician and writer, Girolamo Fracastoro, gave the disease its namein his poem "Syphilis sive morbus Gallicus" (Syphilis or the French Disease),published in 1530 during the height of a European epidemic. However, for centuries, the disease was called pox or the great pox. At that time, treatmentwas mercury, used in vapor baths, as an ointment, or taken orally. The mercury increased the flow of saliva and phlegm, supposedly to wash out the poisons, but it also caused discomfort such as loss of hair and teeth, abdominal pains, and mouth sores.

Through the centuries, a milder form of the disease evolved and often becameconfused with gonorrhea. In 1767, physician John Hunter infected himself withfluid from a patient who had gonorrhea to prove these were two different diseases. Unknown to Hunter, the patient also had syphilis. Hunter developed thesore indicative of syphilis that now bears his name. The distinction betweenthe two diseases was made clear in 1879 when German bacteriologist, Albert Neisser, isolated the bacterium responsible for gonorrhea.

In 1903, Russian biologist Elie Metchnikoff and French scientist Pierre-Paul-Emile Roux demonstrated that syphilis could be transmitted to monkeys and then studied in the laboratory. They also showed that mercury ointment was an effective treatment in the early stages.

Two years later, German zoologist Fritz Schaudinn and his assistant Erich Hoffmann discovered the bacterium responsible for syphilis--the spiral-shaped spirochete called Treponema pallidum. The following year, German physician August von Wassermann (1866-1925) developed the first diagnostic test for syphilis based on new findings in immunology. The test involved checking for the syphilis antibody in a sample of blood. One drawback was that thetest would take two days to complete.

In 1904, German research physician Paul Ehrlich began focusing on a safe, effective treatment for syphilis. Ehrlich had spent many years studying the effect of dyes on biological tissues and treatments for tropical diseases. His work in the emerging field of immunology earned him a Nobel Prize in 1908.

Ehrlich began working with the arsenic-based compound "atoxyl" as a possibletreatment for syphilis. Japanese bacteriologist, Sahachiro Hata, came to study syphilis with Ehrlich. Hata tested hundreds of derivatives of atoxyl and finally found one that worked, number 606. Ehrlich called it "Salvarsan." Following clinical trials, in 1911 Ehrlich and Hata announced the drug was an effective cure for syphilis. The drug attacked the disease germs but did not harmhealthy cells; thus, Salvarsan ushered in the new field of chemotherapy. Ehrlich went on to develop two safer forms of the drug, including neosalvarsan in 1912 and sodium salvarsan in 1913.

Penicillin came into widespread use in treating bacterial diseases during World War II. It was first used against syphilis in 1943 by New York physician,John F. Mahoney, and it remains the treatment of choice today. Other antibiotics are also effective.

Meanwhile, Russian-American researcher Reuben Leon Kahn (1887-1979) developeda modified test for syphilis in 1923 which took only a few minutes to complete. Another test was developed by researchers William A. Hinton (1883-1959) and J. A. V. Davies. Today, syphilis is diagnosed either by signs and symptoms, microscopic examination of a lesion specimen, and fluorescent antibody blood tests. There is no inoculation against the disease.

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